Eliminating racial disparities in health is a top priority public health goal. African Americans have worse health outcomes and receive worse quality of care for a wide range of diseases, but addressing all of these various disparities in health and health care is not feasible. Instead, we must make judicious use of limited resources and target those aspects of health care that will produce the greatest reduction in health disparities. In short, an evidence- based strategy for eliminating racial disparities in health is critically needed and should prioritize those aspects of care that will have the biggest impact on reducing the racial gap in life expectancy. The evidence base to support such a strategy is currently lacking, however. We have previously found that, at the national level, the causes of death contributing most to the racial disparity in life expectancy are hypertension, HIV and homicide. Substantial geographic variations in demographics and health behaviors exist in the U.S. Thus one might expect that the causes of death and risk factors contributing most to racial disparities in health would also vary substantially by geographic region and between metropolitan and rural areas. In fact, we have preliminary data suggesting that the causes of death contributing most to the racial gap in life expectancy differ greatly from state to state. Thus, developing a strategic approach at the state and local level must not only identify which risk factors and health problems to target, but must also identify the right targets for the right population. In prior work, we have developed the Disparities Health Policy Model, which simulates disease and mortality events, to understand how racial, ethnic and socioeconomic disparities in health develops over the lifespan. In this Phase I STTR study, we will test the feasibility of adapting this model and using it as a tool to help public health officials make policy decisions about future research and population-level interventions to reduce health disparities. In this study, we will consult with public health officials with the State of California and Los Angeles County and determine their existing methods for assessing health disparities and identifying targets for interventions. We will then use the Disparities Health Policy Model to identify priorities for eliminating racial disparities in the US, California and Los Angeles County. We will focus on specific causes of death as well as the absolute and relative impact of 4 common disease risk factors (tobacco use, diabetes, hypertension and hypercholesterolemia), ischemic heart disease, and 17 specific types of cancer on the racial difference in life expectancy. We will test the validity of our projections with known life expectancy estimates from US Vital Statistics data. Finally, will produce a report for California and Los Angeles County public health officials identifying key priorities for eliminating racial disparities in life expectancy based on our simulation model. PUBLIC HEALTH RELEVANCE: The proposed study will test the feasibility of using the Disparities Health Policy Simulation Model as a tool for setting priorities and policy decision making about future research and population-level interventions to reduce health disparities. This model estimates the contribution of various diseases, risk factors and aspects of care to racial disparities in life expectancy. This model can be tailored to a specific population, so that public health officials, policymakers, community leaders and healthcare administrators can use the results of this study to identify which diseases, risk factors and aspects of care should be prioritized as targets in future interventions and research to reduce the racial gap in life expectancy in their local populations.